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Bringing Out the Bully Pulpit On Health Care

President Barack Obama is trying to seize back control of the health care narrative. AP Photo/Alex Brandon

The news today that President Obama will hold a prime-time press conference Wednesday came just minutes after he finished an impromptu address on health care -- the two latest pieces of evidence that the White House will lean heavily on the chief executive's personal popularity and magnetism to get a health care bill to his desk.

The White House, which contains any number of politically minded operatives, knows full well that the best way they can convince wavering members of the House and Senate to line up behind the health-care reform push is to take full advantage of the bully pulpit afforded to Obama.

No politician can match the news coverage that any president can command -- particularly one as popular as Obama -- with a series of well-orchestrated media appearances on a given topic.

Many smart observers of the Senate argue that the cable news coverage of the health care debate has been overly negative. Nevertheless, it is clear that the White House believed that it needed to seize back control of the health-care narrative -- particularly after the testimony of Congressional Budget Office Director Douglas Elmendorf drew wall-to-wall coverage yesterday. Elmendorf suggested the legislation would reduce costs by a significant amount but not enough to keep the national debt from continuing to rise.

Obama said this afternoon that much progress has already been made and action must be taken now, and that message is likely to frame much of the coverage heading into a weekend where health care will be the topic du jour on all of the Sunday talk shows.

"I realize that the last few miles of any race are the hardest to run, but I have to say, now is not the time to slow down, and now is certainly not the time to lose heart," Obama said today. "Make no mistake if we step back from this challenge -- at this moment -- we are consigning our children to a future of skyrocketing premiums and crushing deficits. There's no argument about that."

Expect more of that sort of messaging coming from White House surrogates on the Sunday shows -- Health and Human Services Secretary Kathleen Sebelius on "Meet the Press", for example -- and for Obama to echo the "progress/urgency" message in his opening remarks Wednesday night.

That will mark the fourth prime-time press conference Obama has given since taking office. (The dates of the pressers are February 9, March 24 and April 29.) Obama also gave a daytime presser on June 23 in the White House Briefing Room.

The way it looks now, Obama is blowing health care. He should have picked Hillary as Health and Human Services. Make Medicare for all and stop reinventing the wheel. It wil take the greed out of medicine and make the US in sync with the rest of the world-civilized.

The U.S. pays substantially more for substantially worse outcomes than other industrialized nations. Reform isn't about soaking the rich. It's about getting better outcomes for our dollar. Only an ideologue or someone who personally profits from current inefficiencies could argue with that goal. Apparently, a lot of people fall under one of those two headings.

Sorry mark but we are going to have to leave it at agreeing to disagree on supply-demand equillibria. I've been hearing this all my life but it appears to me that it's failing. I only see it working on the smallest scales, like a farmer's market or the bizarre practice among the Vietnamese of putting all the stores in direct competition on the same block.

When you can walk from one fruit stall to another and make direct comparisons, competition operates.

When you just want a f*cking bottle of f*cking aspirin because you have a f*cking headache, and it turns into a 20-minute decision, I really don't see how one's interests are served, since you're likely to get home and find you've gotten a bottle of antacid by mistake.

I love Puppy Linux, and DamnSmall, and all those old-machine distros. But I was amazed to see that my very old W98-era Dell Latitude runs the new Debian as well as Puppy. Puppy would not install to the disk correctly, not without me taking a lot longer to fix it than I cared to.

I think Windows peaked in robustness with Win2K, and in usability with XP (after two service packs, I mean, the original release had way too many bugs). The shell changes in Vista are infuriating, and I know Windows too well to be hoodwinked, many of the prominent changes represent bugs they couldn't fix and decided to paste over.

Office peaked at O2003, and every major change since has been a random regrouping of features, hiding the commonly used ones behind useless ones, and the addition of features nobody needs.

I nurture hope that something happens to nudge people into trying Linux, because the only thing keeping it on the fringes is obscurity. It's no harder to use than Windows, except for the really geeky distros like Crux.

chris, if there were ""too many" private label brands of aspirin, some would go out of business. If there were "too few", small local pharm labs would step in to make and sell more, until there were again "too many". Equilibrium in a competitive market is determined in that rough way.

I previously used SUSE and RedHat; now I use UBUNTU and PUPPY.
PUPPY is a life saver for old slow machines and a simple
system to completely master for newbies, as well.
XP will be the last Windows system on any computer of mine, as well.

I'm posting on my IBM Thinkpad running Fedora 11. XP will be my last version of Windows. I worked on Vista back when it was called Longhorn, and I hated it and I still do. W7 is just a service pack, by the way.

I've given away about a dozen computers to friends and mailing-list acquaintances whose machines died and who couldn't afford new ones. In all cases since I left MS (and can no longer get free Windows licenses) those machines have run some version of Linux, usually Fedora. None of these are technical people by any stretch and all of them are using Linux and having no problems.

Not only do I get to evangelize Linux, but I permanently deprive Microsoft of a customer.

I first worked there in 1989 .. fantastic, wide open, intelligence and ideas crackling in the very air. Now it's like the Kremlin. The Vista project was managed by some sort of test-to-destruction libertarian types, every imaginable obstacle to productivity thrown in our path with the Hooveresque idea that the best would bubble up to the top. What bubbled up were the drones, the most passive followers of orders.

Now MS is a culture of standardization and uniformity and consistAncy (sic), an idea gets you in trouble, and being in trouble gets you terminated. Where people once worked late because they loved their work they now work late because they're terrified of their next annual review. I'm glad to not be there anymore, in '89 I was bursting with pride to be there.

Agreed on house-brands for aspirin, that's what I buy, but do we really need so many? No.

My apologies to all for permitting my emotions to get the better of me the other day and post such an overly emotional 'rant'. My only excuse is that the parents of several close friends of mine have died recently ONLY b/c they were part of the 47 million uninsured, so it hit a nerve.

The fundamental truth is--however distasteful--that health care is a for-profit industry in the US. Anytime a vital segment of the economy is primarily for profit, the public loses (unless you're a shareholder, of course).

At one point or another, EVERYONE--young, old, affluent or not, healthy or ailing, gets ill. It's inescapable. With people living longer, it's even more likely. If one is lucky, these things don't beset one until one's 60s or later.

Sometimes it isn't even a question of age or lifestyle--it can be something like a car or other type of accident. REGARDLESS, people cannot be allowed to die in the street b/c the health care system deems them inadequate. Not in a civilised society such as most people believe the US to be.

To sirkfish, et. al.:

I agree with many of your solutions, if only politicians would listen, but they're swayed--if not exclusively, at least mainly--by purely political concerns, not the welfare of the populace as a whole.

Apparently, Minority Leader Mitch McConnell was on one of the Sunday shows doing that tired old 'America has the finest health care system in the world' line, but even if that were true (which is highly debatable), what good is having the finest health care if it's unaffordable or unavailable to the huge majority of the populace?

CF8, I think your "aspirin" example works in favor of competition. Aspirin does not require a large investment to permit commercial production of the product. No economies of scale are apparent from building enormous aspirin factories. As a result, consumers are able to buy aspirin very cheaply and the profit margin is driven down to an irreducible minimum because Walgreens and CVS and the local pharmacy and regional food market chains all have private label brands that sell for less than half the price of Bayer.

Why does Bayer cost so much? Consumer ignorance. Market segregation can still work for the biggest advertiser. For the smart consumer, aspirin can be bought at the competitive price.

As I recall, Sony did not license BetaMax while VHS was freely licensed. Thus VHS became cheaper because of competition, which Sony stifled. The quality advantage was overcome by the price disadvantage.

Related note:

Unix and its derivatives [incl. Mac and linux] are better than Windows. Mac costs more because of its tie-in insistence. Free linux will have to overcome the head start Windows built with software app designers, but I use linux as often as I use Windows and more often than I use the Mac - and when my VMWare is good enough to easily run the law apps designed for Windows I will be able to discard Redmond, altogether.

I now use OO3 instead of MS Office, btw. I am someone who will not bet the future on the Windows desktop.

I wasn't talking so much about healthcare, mark, I was talking about the reverence for the power of competition. I don't believe in it.

I really don't see any great levelling advantage in having dozens of companies putting out indistinguishable products. Aspirin is aspirin, we really don't gain anything by having thirty brands to choose from. Go to a shopping mall with two hundred stores and really there are only a few dozen different experiences because dozens of them are selling the same things.

Many different companies racing to bring the same products and services to market means that they're going to be doing the same things, competing with each other, many of them won't make it and no I don't believe that the best or the cheapest always prevail. Beta was better than VHS. The losers end up in landfill. I don't like it.

So head-out first-thing Monday morning and jump in your Prius with the "Change" bumper-sticker on the back and GET TO WORK...

==

And you jump into your Escalade with the McCain Palin bumper-sticker on the back windshield and head to the pump so you have enough gas to get to the next pump. On the way there you can buy a new box of votive candles for your shrine to Ronald Reagan

I would argue that oligopoly and monopoly are wasteful, that suppression of information and market segregation are wasteful, but that because of non-economic social costs [I am not an economic determinist] competition does not resolve the unavailability of health insurance. In this market, competition dictates excluding the old and the sick. That should be socially unacceptable, and if it is, then the competitive model cannot be the basis for "pricing" health care insurance.

On the other hand, the competitive model can give us clues as to how to reduce aggregate health care costs to the society. Examples? As others have noted, the availability of more general practitioners and nurse practitioners and public health nurses will increase the supply of front line health care and preventative health care.

There is much more to be said here, but I am merely drawing a distinction between the aggregate cost of health care, where competition is a "good thing", and the availability of health insurance, where competition works to deny coverage to the lame and the halt.

Well, limousine liberals and MSM "elites", you had your fun... and probably almost broke your arm patting yourself on the back when you got the Dear Leader elected.

Now you are getting the taxes you deserve, as Barack Obama is going to BLEED YOU DRY. And you can forget writing off your local taxes on your overpriced eastcoast/leftcoast home... you’ll be paying more on that, too.

And here’s the kicker: you’ll be sending alot of that money to people in red states... to people whom you can’t stand.

New Yorkers, Californians, residents of the Northeast and the D.C. Corridor, you elected Obama… so step-up and pay those absurd taxes without complaining. You wanted bigger government.. so try THIS on for size.

Those who live in places with more rational state tax structures like Texas and Nevada will welcome you when you want to move there... well not really, LOL.

So head-out first-thing Monday morning and jump in your Prius with the "Change" bumper-sticker on the back and GET TO WORK...

Seems to me as though there is a truly progressive tax compromise available that would provide the increased revenues necessary to pay for health care reform without breaking our President's promise that those making less than $250,000 will not pay higher taxes, and that will have a better chance of gaining control of spiraling health care costs. In addition the idea I am suggesting would have the added benefit of providing an additional short-term economic stimulus.

Let's keep the rich folks' tax surcharge passed by House Ways and Means and add to that the taxing of high-end health benefits packages such that real savings are achieved in health care costs as a result.

Whether the level at which a tax on health care benefits becomes effective is $15,000 in estimated annual benefits, $17,000, or whatever value is determined to be necessary to ensure that the plan is sufficient to both pay for the extension of coverage to the uninsured and necessary reform, while also sufficient to "bend" the cost curve on health care while achieving universal coverage, I leave to the number-crunchers like Orszag and others. The joining of these two revenue mechanisms will ensure ample money to pay for the cost of reform and should satisfy critics like the Congressional Budget Office who say the current plans passed by the various Congressional committees do not reap sufficiently large health care cost savings and therefore do not adequately restrain long-term deficits.

Now to offset the potential negative effects of health-care benefits taxation on moderate-income citizens who would not be subjected to the rich folks' tax surcharge, let's cut the payroll tax in a manner such that those earning less than $250,000 will see NO NET tax increase.

This plan would be even more progressive than any of those presently advocated. It would contribute to providing increased health care cost reductions while also ensuring that the plan is paid for. It would also provide tax relief to small businesses in the depths of a recession, while also putting more money directly into the hands of workers. And it would ensure that middle-class citizens do not see their overall taxes increased.

"1. Increase the number of doctors. The government could open several medical schools & give a free medical education to anyone who qualifies. These doctors could repay thier educactional costs by working for the government, helping low income citizens, for 5 years. Also, increasing the number of doctors increases competition which lowers prices."

The bottleneck on doctors isn't due to the cost of med school. It's the number of slots. It's expensive, but students take loans without a second thought knowing that they will easily pay off the debts.

This is ridiculous. For the citizens who want national healthcare, you need to be realistic. The only way to fund such an undertaking is to tax EVERYONE! It should work just like Social Security: everyone pays a percentage of their pay, regardless of their income level. Anyone not willing to start paying such a tax, does not want healthcare. In addition, there are a lot of obvious ways to reduce costs which don't show up in the current legislation:

1. Increase the number of doctors. The government could open several medical schools & give a free medical education to anyone who qualifies. These doctors could repay thier educactional costs by working for the government, helping low income citizens, for 5 years. Also, increasing the number of doctors increases competition which lowers prices.

2. Limit medical malpractise suits. Under the current system, billions of healthcare dollars are wasted on bogus malpractise suits. Every citizen pays part of this cost. This would also reduce expensive and unneccessary tests and procedures.

3. Stop paying for the healthcare of non-citizens. What other countries pay for medical costs of their non-citizens? This would save billions of dollars.

Finally, just to make sure your elected officials are not cooking their books, require the Congress, Senate and the President & Vice President to subscribe to the government run option and make it illegal for them to use any other coverage.

Health care is already rationed in this country, by how much money you have. If you're middle-aged and self-employed, as margaret states, you're just plain screwed. You either pay a fortune, or you die.

I found these paragraphs telling, in light of some of the discussions that have taken place on this board on the merits of the economics field in general.

"But economists were hardly naive believers in market efficiency. Financial academics have spent much of the past 30 years poking holes in the “efficient market hypothesis”. A recent ranking of academic economists was topped by Joseph Stiglitz and Andrei Shleifer, two prominent hole-pokers. A newly prominent field, behavioural economics, concentrates on the consequences of irrational actions.

So there were caveats aplenty. But as insights from academia arrived in the rough and tumble of Wall Street, such delicacies were put aside. And absurd assumptions were added. No economic theory suggests you should value mortgage derivatives on the basis that house prices would always rise. Finance professors are not to blame for this, but they might have shouted more loudly that their insights were being misused. Instead many cheered the party along (often from within banks). Put that together with the complacency of the macroeconomists and there were too few voices shouting stop."

This strikes me as a problem in all fields of science. The worlds of research and applications seem to be dangerously disjoint. For things like biology, it isn't so bad. I doubt any of us can synthesize our own drugs or IVF ourselves. For economics, its worse. Anyone can get a loan and buy a house or participate in the stock market. The scientists are in their own bubble of research and while they might be getting it right, their findings don't seem to make it out into the public sphere very efficiently. As a result, this void in economics knowledge is filled by dishonest politicians and businessmen with their own agendas. This will always be a problem unless the actual economists find a way to have their voices heard. It's not easy. It's a lot harder for an economist, someone likely untrained in communication, to give a nuanced analysis that can compete with Sean Hannity screaming about free markets and socialism. Biologists have the same problem. It's tough to convince people to get their vaccinations when people like Jenny McCarthy are out there screaming about autism.

But there needs to be a solution. The people who perpetrated this financial mess are making out like bandits. Sure, the banks may be failing, but the individuals are immensely wealthy. The talking heads will always have their jobs in political and punditry circles.

There are lessons to be learned from the past and present and it is very likely that people are learning these lessons. Unfortunately, the loudest voices are the ones that benefit from disinformation.

While I hold the study of economics in higher repute than does CF8, I certainly believe that post-Keynesian, post-Friedman views have not proved to work in the world.

This may be because I studied economics in the early 60s and believed what both Keynes and Friedman wrote about fiscal policies on the one hand and monetary policies on the other. So as an old codger, I viewed the Reagan era shibboleths of laissez faire with suspicion.

Lisa421, whether you know it or not, we already have socialized the cost of our (ill) health. We all pay the cost of the profits made by hospitals and insurers. We all pay for the relentless ER visits of the uninsured, we pay for the excellent health care received by the inmates of the war on drugs, we pay and pay and pay and there is no way to avoid these costs - trying to makes everything even more expensive.

The pathetic Ted Nugent fantasy about "conservatives" taking care of themselves, somehow insulating themselves from the cost of a system that is falling apart...how delusional can you people be?

So, health reform is about biting down hard on socialized medical costs. We pay them either way, so we might as well do it right, efficiently in other words, like the guy from Sweden talks about below.

But if Obama is going to sell socialized medicine to the Congress, he has to convince them that the very large initial cost of building a coherent system of care will not hurt them come election time.
He has to be able to have congress people say "This was President Obama's thing and you voted for him."

Therefore, the less people tune in to Obama's Press conference, the better. There is no organized popular demand for health care reform and there is no organized, popular opposition to the effort. Obama needs to keep it that way otherwise the legislation will be gutted and killed.

So if the networks run infomercials instead of Obama, that will be just fine. Right now, apathy is good because health care reform is a really big ticket item.

charlietuna I know plenty of elderly conservatives who are glad to be over 65 and getting gov't healthcare. I know a lot of others who get coverage through their employers -- because of the size of the contract, a large emloyer has a chance to negotiate OK insurance with defined coverage at a livable rate.

BUT conside the huge market of self-employeds and small business owners and retired folks who are not yet 65 (this include a lot of police officers -- I work with ex-cops and they no longer have coverage between the time they leave the PD after 25 years and the time they reach retirement age). I have several friends who are self-employed and in their 50s. They still have years to go before medicare. They are paying 2K and UP a month for coverage that excludes their pre-existing conditions (and at 50 my friend, just about everything is a pre-existing condition). They can lose this expensive coverage any time they become less profitable to the insurance company so they pay their premiums and they pay for everything that is excluded and they hesitate to place new expenses on their insurer.

As long as we are kept divided, ill-informed and scared by insurance companies and hospitals (won't tell you costs up-front, and charge different prices for the same services depending on who pays), and doctors (referring you for extra tests because that increases their bill -- and maybe they are part-owner of that imaging center) Americans will continue to pay a ridiculously HIGH price for ridiculously POOR care.

If we're going to have a tax to pay for health care upfront costs, then a Financial Transaction Tax (FTT) that would limit speculation and self-generated volatility, and is estimated by CEPR to generate $66-$130 billion, is probably a preferable tax. Speculation and volatility generation are just like smoking, costly, addictive, and harmful to people around the perpetrators. And it would not hurt long term investors.

We conservatives have provided for our own health care. Why do you liberals who evidentally don't provide for your own health care try to make us pay for your health care. Why are we being made to pay for your health care? We conservatives take care of our own children and loved ones. You liberals must be really low achievers not being able to provide for yourselves. You liberals are just pulling the rest of us down. Man up liberals and quit trying to steal from us working, successful folk for your needs. Contribute to society instead of just mouthing off like you are entitled.

I don't think many people could have summed up the case for an even MORE radical (i.e., extensive; not politically) overhaul of this country's appalling healthcare crisis.

Coming from a country with completely (Govt.) paid health care AND dentistry, I deeply resent the usual fear & smear tactics so successfully used by the Right and their pharmaceutical and health insurance overlords.

How is having to regularly wait 45 mins. or more for an appointment with a US doctor any different from a wait for a National Health Service doctor?

Is health care in this country not already rationed when people have to go to only a select number of doctors if one has a POS health plan?

Is health care not rationed when it takes 3-5 WEEKS to get an appointment and the only other choice is a trip to the ER?

Is health care not rationed when the pills that are prescribed for a number of illnesses cost more than what many people have to live on each month?

And then these sanctimonious wankers say 'This country's medical care is the envy of the world' when, in reality, that is only true if one has a tremendous amount of money and/or a very rare illness which requires highly technical machinery to deal with.

I'd best watch it, or I'll get so upset I'll give myself a stroke!

Just one last remark: Full and complete health coverage (including dental) is EVERYONE'S right, not just a privilege for the rich and healthy!

Just think how conservatives will cheer if healthcare reform fails. And when they themselves bury their loved ones after care is denied, they'll find someone liberal to blame, using some logical acrobatics.

Then they'll go back to crowing about how conservatives believe in responsibility, and they know where their self-interest lies better than any "bureaucrat."

We already spend over 16% of our GDP on A in this country (CRS #s) and what do we get for our money?

*Rx companies prosper at our expense by keeping medications at artificially high rates in this country, and then use scare tactics so we won't buy their drugs in Canada at lower prices.
*Hospitals bill the same services at different rates depending on who is paying the bill. Go figure.
*Doctors order all kinds of tests, relevant or not, because there are financial insentives for doing this (I know -- they are also protecting themselves from lawsuits), and they see you for 12 minutes because that optimises their billing.
*Millions of people go uninsured -- which costs us a lot of money in the long run when simple clinic visits end up in the ER instead.
*Millions of other people pay 24K a year for private insurance that excludes their pre-existing conditions and can be cancelled at any time if they are no longer profitable to the insurer.
*Insurance companies charge for services that should have been covered in their policies (you can chase them for a refund if you figure it out) AND deny treatment that should be covered (you can grieve it if you are still alive). They keep us divided, ill-informed and helpless because that makes them more money.

Over 16% or GDP and rising steadily, and by most metrix our general health care is not as good as that in any of the countries that have gone to universal coverage. Our current set-up is pathetic.

Well-defined coverage at reasonable cost should be made available to everyone in this country. Congress and the Senate need to make the same health care they enjoy available, at cost, to everyone.

Trust me, those wealthy democrats are more afraid of loosing their "good gobement JOBS FOR LIFE!!", than they are concerned about "tax increases". Thats just another shield for them to hide behind. SCREW HIGHER TAXES!!! WHATEVER IT TAKES TO BRING DOWN THE GREEDY BLOODSUCKING INSURANCE COMPANIES AND HMOs!!!!!!!!!! SUPPORT THE PRESIDENT, DAMNIT!! YOU PEOPLE P!SSING AND MOANING ABOUT HIGH TAXES ARE THE ONES WHO NEED HEALTHCARE MORE THAN THE POLITICIANS!!!!

Obama is a greater communicator than Reagan was, and he's a lot smarter. He needs to explain to the American people that the rest of the developed world gets better care than we do for half the price, and the reason for the difference is that healthcare is run by companies seeking to make money.

I think the American people can handle hearing about motives other than "getting rich" by now.

No, I don't "get it." Are you really saying that it doesn't matter whether all (or any) TV carries President Obama's press conference live on Wednesday night? That wouldn't be too big of a "bully pulpit."

I think it was a good pitch by Obama. But i found it interesting that he tried to separate what we need to do to pay for the initial ten years vs. long term. So he seems to be saying he and Congress should say trust us- we will do the long term fixes later we just need the trillion or more dollars for now. I find that a little scary.

Its time for Obama to kick @ss and take names. Those timid democrat are afraid of loosing campaign contributions from the insurance companies and HMOs. They could care less about the American people. They're all a bunch of greedy wussies...

Obama needs to assert stronger leadership if meaningful health care reform as opposed to a weak health care bill is enacted this year. He should make clear, being at least somewhat specific, not general and vague as is his tendency on this issue, in what must be in any health care bill to be acceptable to him.
This should include higher taxes on the wealthy, at least 400% subsidies for those who will coerced to buy health care insurance, a public option and, in keeping with his campaign promises, no new taxes on those receiving less than $250,000 a year.

Otherwise there is a significant likelihood there will be a weak, unfair bill enacted, with new financial burdens upon many elderly people and those in the middle class. Health care costs will all but inevitably continue to increase higher than the official rate of overall inflation if there is no public option, to offer competition to private insurance companies.